CHAPTER 410: NURSING UNITS

Department of DefenseThe Office of the Assistant Secretary of Defense Health AffairsWashington, DCDoD Space Planning CriteriaChapter 410: Nursing Units17 January 2013CHAPTER 410: NURSING UNITS1Purpose and Scope . 410-22Definitions. 410-23Operating Rationale and Basis of Criteria . 410-64Program Data Required (Input Data Questions):Medical-Surgical Units . 410-95Space Planning Criteria:Medical-Surgical Units . 410-106Program Data Required (Input Data Questions):Intensive Care Units (ICU) / Coronary Care Units (CCU) . 410-177Space Planning Criteria:Intensive Care Units (ICU) / Coronary Care Units (CCU) . 410-188Program Data Required (Input Data Questions):Pediatric Units . 410-259Space Planning Criteria:Pediatric Units . 410-2610 Program Data Required (Input Data Questions):Substance Abuse / Alcohol Rehabilitation Units. 410-3211 Space Planning Criteria:Substance Abuse / Alcohol Rehabilitation Units. 410-3312 Planning and Design Considerations . 410-3813 Functional Relationships . 410-4814 Functional Diagrams . 410-5015 Appendix A: Space Planning Criteria Summary . 410-55Page 1 of 83

Department of DefenseThe Office of the Assistant Secretary of Defense Health AffairsWashington, DC1DoD Space Planning CriteriaChapter 410: Nursing Units17 January 2013PURPOSE AND SCOPEThis chapter outlines space planning criteria for hospital-based inpatient nursing units forall Military Treatment Facilities (MTFs) in the Military Health System (MHS). This spaceplanning criteria applies to the following types of nursing units: traditional acute careMedical - Surgical Units, Intensive Care / Coronary Care Units (ICU/CCU), IntermediateCare Units, Pediatric Units, Substance Abuse / Alcohol Rehabilitation Units, and AcuityAdaptable Units. Substance Abuse / Alcohol Rehabilitation Units provide care to patientsrecovering from alcohol and related substance abuse.These criteria should not be used for the following services:A. Obstetric Units; refer to DoD 420: Labor & Delivery / Obstetric UnitB. Nurseries; refer to DoD 460: NurseryC. Prep and Recovery Units, and Post-Anesthesia Care Units; refer to DoD 440: SurgeryD. Inpatient Pharmacy; refer to DoD 550: Pharmacy: Inpatient & OutpatientThis space planning criteria applies to all Military Medical Treatment Facilities (MTFs).Policies and Directives, DoD’s Subject Matter Experts (SMEs), established and/oranticipated best practice guidelines / standards, and TRICARE Management Activity(TMA) provide the foundation for the workload based space criteria and Net SquareFootages (NSF) for each space. The latest version of DoD’s UFC-4-510-01, Appendix Bcites all Room Codes identified in this chapter.2DEFINITIONSA. Acuity Adaptable Room: An acuity-adaptable patient room is a single-occupancyroom that can be used as critical care, intermediate care, acute care and short staycare (23 hours or less) by altering its monitoring equipment, furnishings, and staffinglevels. These patient rooms can be adapted to changing demand and patientpopulations over time with minimal or no renovation.B. Anteroom: An enclosed ventilated room adjacent to the isolation room whose purposeis to provide a barrier against the entry/exit of contaminated air into/out of theisolation room. As well, it provides a controlled environment for donning/removal ofPPE, decontaminating equipment, and handwashing. The anteroom is not required.C. Average Length of Stay (ALOS): The length of stay for an individual patient is thetotal amount of time that he/she stays in a healthcare facility between arrival(admission) and departure (discharge) and is determined based on the midnightcensus. The average length of stay for a specific patient population or facility is thetotal of all patient days (lengths of stay) divided by the number of patient admissions /discharges.D. Coronary Care Unit (CCU): An intensive care unit that provides care to patients with avariety of cardiovascular illnesses and related medical issues. The nursing staffreceives specialized training in the care of patients with cardiac arrhythmias, chestpain, heart failure, and other critical medical conditions.E. Care Giver Workstation: Workstation for nursing unit personnel. Workstations can be“centralized” or “decentralized”. An example of “centralized” is the central nursingstation that serves as the information hub of the unit and contains workspace for allcare givers. An example of the “decentralized” workstation are care giver workstationsthat are distributed throughout the nursing unit, often located outside each patientPage 2 of 83

Department of DefenseThe Office of the Assistant Secretary of Defense Health AffairsWashington, DCDoD Space Planning CriteriaChapter 410: Nursing Units17 January 2013room or between every two patient rooms to allow a caregiver to work efficiently whileobserving and caring for patients. Additionally, decentralized “teaming” workstationsor substations can be provided for several caregivers to collaborate about thepatient’s care.F. Clean Utility Room: This room is used for the storage and holding of clean and sterilesupplies. Additionally it may provide space to prepare patient care items. Clean linenmay be stored in a designated area in the clean utility room if space is not provided ina separate room or in an alcove.G. Consult Room: This is a consultation room for family members to meet withphysicians or other providers privately and is ideally located near the waiting room.H. Full-Time Equivalent (FTE): A staffing parameter equal to the amount of timeassigned to one full-time employee. It may be composed of several part-timeemployees whose total time commitment equals that of a full-time employee. OneFTE equals a 40-hour a week workload.I.Functional Area: The grouping of rooms and spaces based on their function within aclinical service. Typical Functional Areas are Reception Area, Patient Area, SupportArea, Staff and Administrative Area, and Education Area.J. Input Data Statement: A set of questions designed to elicit information about thehealthcare project in order to create a Program for Design (PFD) based on the criteriaparameters set forth in this chapter. Input Data Statements could be mission related,based on the project’s Concept of Operations; and they could be workload or staffingrelated, based on projections for the facility.K. Intensive Care Unit (ICU): A nursing unit that is specially staffed and equipped for theobservation / monitoring, care, and treatment of high-acuity patients with lifethreatening illnesses or injuries. The ICU provides special expertise and facilities forthe support of vital function and utilizes the skill of nurses and other staff experiencedin the management of these problems.L. Medical - Surgical Nursing Unit: A Medical - Surgical or “Med-Surg” nursing unitprovides general and acute care for patients with medical problems or for thoserecovering from surgery. For example, it may be a nursing unit for patients who arebeing served by physicians trained and/or practicing the following specialties: allergy,dermatology, pulmonary disease, cardiology, gastroenterology, communicabledisease, neurology, malignant disease (oncology), telemetry, other medicalspecialties, gynecology, otology, thoracic surgery, neurosurgery, otorhinolaryngology,plastic surgery, orthopedics, proctology, and other surgical specialties.M. Medication Room: This room will include space for medication storage and suppliesfor automated dispensing machines.N. Negative Pressure Isolation Room: A type of Airborne Infection Isolation Room that isprovided for the isolation of patients with airborne contagious diseases such astuberculosis and is designed to direct air flow from outside corridors and rooms intothe patient room, preventing the chance for contaminated air to flow to other parts ofa building. The use of an anteroom is not mandatory; however, its need should bediscussed with the facility.O. Net-to-Department Gross Factor (NTDG): This number, when multiplied by theprogrammed net square foot (NSF) area, determines the departmental gross squarePage 3 of 83

Department of DefenseThe Office of the Assistant Secretary of Defense Health AffairsWashington, DCDoD Space Planning CriteriaChapter 410: Nursing Units17 January 2013feet (DGSF).P. Nursing Unit: A group of inpatient beds with all the functions necessary to providecare to the patients on the unit.Q. Office:1. Private Office: Generally speaking, a private office is needed for the supervisoryand/or managerial role. It may be justified for a provider or a non-provider,depending upon the nature of their work. Private offices are needed whereconfidential communication in person or on the telephone takes place. Whenprivate offices are justified, they are typically 120 NSF.2. Shared Office: Staff may be assigned to share an office space of 120 NSF, whichamounts up to 60 NSF per person. This can be a good solution for staff for whoma quiet office environment is important for conducting confidential communicationin person or on the telephone.3. Cubicle: A cubicle is provided in an open room. Managers and other staff with nodirect reports as well as part-time, seasonal and job-sharing staff may qualify for acubicle environment. Cubicle environments can have the benefit of being moreopen, airy and light, and can make more efficient use of space. Suchenvironments are particularly conducive to team-oriented office groupings.Cubicle environments work best when they contain adequate numbers ofconference and small group meeting spaces, for confidential conversations and/orgroup tasks. A 60 square foot cubicle is the preferred size.R. Pediatric Unit: A group of inpatient beds with all the functions necessary to providecare to infants and children less than 18 years of age on the unit.S. Personal Property Lockers: This is a small-sized locker, commonly called purse orcell phone locker, and is generally used to secure purses and smaller valuables. Staffmembers who do not have an office or cubicle space where they can safely storebelongings will be assigned these lockers.T. Playroom: This space is provided to accommodate children’s play activities; it shall beoutfitted with appropriate furniture and accessories and included within the GeneralWaiting.U. Point-of-Care (POC) Lab: A testing room on the Nursing Unit used to conduct bloodgas analysis and provide testing with transportable, portable and handheldinstruments (e.g., blood glucose testing with glucometers and urine strips). Providesspace for blood gas analyzers, microscopes, small under-counter refrigerator anddata drops. Generally located within close proximity to the patient care area.V. Positive Pressure Isolation Patient Room (Airborne Infection): A patient room that isdesigned with positive pressure / air flow to maintain a flow of air out of the room, thusprotecting the patient from possible contaminants and pathogens which mightotherwise enter.W. Program for Design (PFD): A listing of all of the spaces and rooms included within aservice and the corresponding net square foot area of each space and room. Thislisting of spaces and rooms is based on criteria set forth in this chapter and specificinformation about mission, workload projections and staffing levels authorized.X. Same-handed Configuration: Same handed rooms feature an identical, repeatedPage 4 of 83